Continuous drag ablation versus point-by-point lesion sets for pulmonary vein isolation: A systematic review and meta-analysis
S Chadha, S Rashid, E Aminov, D T ZhangAbstract
Background
Pulmonary vein isolation (PVI) is a cornerstone of AF catheter ablation. The efficacy of continuous “drag” versus point-by-point lesion sets for PVI remains uncertain; we conducted a meta-analysis.
Methods
An unrestricted search of Ovid MEDLINE, Embase, and Web of Science identified studies of drag versus point-by-point ablation in PVI. The primary endpoint was first pass isolation. Secondary endpoints included atrial arrhythmia recurrence at 1 year of follow-up, procedural time, ablation time, fluoroscopy time, and procedural complication rates.
Results
Five studies with 714 patients (324 drag, 390 point-by-point) were included. Mean follow-up was 12.9 months, age 62.1 years, CHA2DS2-VASc score 1.6, 30.4% of patients were women, and 86.3% had paroxysmal AF. Compared to point-by-point, drag lesions had no difference in first pass isolation (OR 0.86, 95% CI 0.51-1.46, p=0.57) (Figure 1a), atrial arrhythmia recurrence (OR 1.18, 95% CI 0.84-1.64, p=0.34) (Figure 1b), ablation time, or complication rates (not shown). Drag was associated with shorter procedures (mean difference 15.9 minutes, 95% CI 11.2-20.6, p<0.001) (Figure 1c), and more fluoroscopy (mean difference 2.1 minutes, 95% CI 0.99-3.3, p<0.001) (Figure 1d).
Conclusion
Continuous drag lesions for PVI in AF catheter ablation showed no difference in first pass isolation or atrial arrhythmia recurrence, but yielded shorter procedures despite more fluoroscopy use, with neutral effect on ablation time and complication rates.